Hypoglycaemia in suppurative pancholanghtis due to Clonorchis Sinensis
01 Mar 1965-Transactions of The Royal Society of Tropical Medicine and Hygiene (Oxford University Press)-Vol. 59, Iss: 2, pp 179-185
TL;DR: It is concluded that surgical removal of the plug of dead flukes and drainage of the biliary tree are essential in the management of the condition and that it should be carried out as early as possible.
Abstract: Over a period of 16 years, to the University Department of Medicine, Queen Mary Hospital, 11 patients were admitted deeply unconscious, with high fever and showing varying degrees of jaundice. In all the coma was associated with severe hypoglycaemia, and correction of this resulted in restoration of consciousness. The histories of the last 10 patients were remarkably similar. After 1–4 days of fever and right upper abdominal discomfort there were repeated rigors associated with distressing distending pain over the liver coupled with vomiting. All lost consciousness within 24 hours of the onset of rigors. The laboratory findings are briefly described. The findings at necropsy in 9 and at laparotomy in 2 were those of a diffuse suppurative pancholangiitis associated with obstruction tot he extrahepatic ducts by large numbers of dead Clonorchis sinensis . It is concluded that surgical removal of the plug of dead flukes and drainage of the biliary tree are essential in the management of the condition and that it should be carried out as early as possible. An investigation of the cause of the hypoglycaemia is described and it is concluded that it results from a hepatectomy-like effect. How the infection exerts this effect has not been determined. It is not due to necrosis of liver cells and is rapidly reversible through adequate treatment.
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TL;DR: Nine patients in whom hypoglycemia (mean serum glucose of 22 mg/dl) was associated with overwhelming sepsis were encountered, and Streptococcus pneumoniae and Hemophilus influenzae, type b, were the most common pathogens, and the over-all mortality was 67 per cent.
148 citations
TL;DR: Patients with suppurative cholangitis seen at the Massachusetts General Hospital over a nine year period had jaundice, abdominal pain, and fever, clinical symptoms were variable, and calculous disease did not recur, except for two patients with retained stones.
Abstract: Twenty patients with suppurative cholangitis were seen at the Massachusetts General Hospital over a nine year period. Fifteen patients had acute obstructive suppurative cholangitis due to complete obstruction of the common duct, many with coma, hypotension, and positive blood cultures. Sixty per cent of patients were older than seventy years, and most had a history of biliary tract disease. Although most had jaundice, abdominal pain, and fever, clinical symptoms were variable. The diagnosis of cholangitis was made in only 30 per cent of patients before autopsy or surgery. Eighteen patients had calculi in the common duct, and two had primary fibrosis of the ampulla. Patients explored less than 24 hours after admission or deterioration died less often than those operated on after some delay. Most patients underwent common duct exploration and four had a concomitant sphincterotomy. In one instance, cholecystostomy only was performed and this patient died because of ongoing sepsis. The overall mortality was 40 per cent; of those subjected to operation, 25 per cent died in the hospital. Recovery was dramatic among most survivors, and calculous disease did not recur, except for two patients with retained stones. Prophylactic cholecystectomy is recommended to prevent the occurrence of this subtle and highly dangerous syndrome.
98 citations
51 citations
TL;DR: Twenty infected newborn infants who had hypoglycemia are presented; eight presented with hypoglycemic symptoms, which were controlled by raising the blood sugar levels, and the infecting organisms were predominantly gram-negative bacilli.
38 citations
TL;DR: Conservative treatment, based on modern sophisticated physiologic measurements, and the use of newer potent pharmacologic agents may lead to an improvement in the patient's condition; however, he or she is still at high risk until decompression of the infected biliary tract is carried out.
Abstract: The clinical courses of twenty-four patients with acute obstructive suppurative cholangitis are described. Conservative treatment, based on modern sophisticated physiologic measurements, and the use of newer potent pharmacologic agents may lead to an improvement in the patient's condition; however, he or she is still at high risk until decompression of the infected biliary tract is carried out. In some cases, operation must be performed upon a moribund patient refractory to all resuscitative measures if survival from this benign disease is to be achieved. Hypoglycemia, thrombocytopenia, and renal shutdown are commonly present in patients with this disease. The possibility that a patient admitted to the hospital with the diagnosis of acute cholecystitis may have or develop acute obstructive suppurative cholangitis should constantly be borne in mind.
33 citations
References
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TL;DR: The term recurrent pyogenic cholangitis as used by Cook et al. is probably more appropriate for the pathological change most evident in the bile ducts, with the liver parenchyma being secondarily involved.
Abstract: Introduction Recurrent pyogenic cholangitis is a common condition in Hong Kong. Digby 1 drew attention to its occurrence in Hong Kong in a paper in which he described 8 cases. Cook 2 et al. described the clinical aspects in 1954, while Stock and Tinckler 3 reported the result of their treatment in cases of cholangiohepatitis, a name suggested by Himsworth 4 in 1947 for a similar condition associated with obstruction of the large bile ducts outside the liver resulting from either an impacted stone or carcinoma of the large bile ducts. Although the pathological picture is that of inflammation of the liver parenchyma as well as the bile ducts, the term recurrent pyogenic cholangitis as used by Cook et al. is probably more appropriate for the pathological change most evident in the bile ducts, with the liver parenchyma being secondarily involved. This condition is characterized by Charcot's intermittent biliary fever
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TL;DR: Most gallstones of Western peoples are cholesterol stones, whereas, in Japan, pigmented calcium stones, including stones of parasitic origin, account for nearly 60% to 80% of all such concretions.
Abstract: Introduction It is well known that the cholelithiasis of the Japanese differs remarkably from that of Europeans or Americans. A difference also is noted in respect to such common diseases as pulmonary tuberculosis, diabetes mellitus, chronic pancreatitis, some malignant tumors, and other states, as they affect the Japanese and as they affect other peoples. However, the differences between cholelithiasis in the Japanese and the same disease in other peoples are most noticeable. Since the time of the late H. Miyake 1 in Kyushu and I. Matsuo 2 in Kyoto, the cardinal differences between the type and location of gallstones in the Japanese and the type and location of these lesions in Western peoples have been pointed out thus: 1. Most gallstones of Western peoples are cholesterol stones, whereas, in Japan, pigmented calcium stones, including stones of parasitic origin, account for nearly 60% to 80% of all such concretions; 2. Most
86 citations